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Revision Flashcards

1
Q

at what point do the ovaries contain the greatest number of germ cells

A

7 months gestation

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2
Q

A 30-year-old pregnant woman undergoes a routine ultrasound scan. The scan reveals a normal pregnancy, however she has two uteri.

What is the most likely embryonic explanation?

A

incomplete fusion of the paramesonephric duct

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3
Q

In males, which structure develops to form the vas deferens (ductus deferens)

A

mesonephric duct

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4
Q

In females, which structure develops to form the superior portion of the vagina?

A

paramesonephric duct

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5
Q

The provision of any assisted conception treatment and research using human embryos in the UK requires regulation.

What is the name of the regulatory body that provides this?

A

the human fertilisation and embryology authority

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6
Q

Research on Human Embryos is legal in the UK.

Up to what stage can this research be performed?

A

day 14

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7
Q

A couple attend an infertility clinic. The man had a vasectomy 5 years ago and was shown to be azoospermic following this.

What treatment option should be offered initially?

A

ICSI with sperm obtained from surgical sperm aspiration

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8
Q

At which stage in embryo development is embryo transfer most successful?

A

blastocyst

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9
Q

A couple present with a 5 year history of unexplained infertility. What is the best course of treatment?

A

IVF

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10
Q

How long do male lice live, on average?

A

22 days

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11
Q

A woman presents in her 3rd trimester with pelvic pain. What structures relax in pregnancy, which could be contributing to her pelvic pain?

A

pelvic inlet

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12
Q

Which structures on the fetal skull outline the vertex?

A

Anterior and posterior fontanelles and the parietal eminences

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13
Q

A non-sexually active woman presents with a vaginal discharge which contains bubbles and has an offensive smell.

What is the most likely infection?

A

bacterial vaginosis

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14
Q

what cells on high vaginal swab can diagnose bacterial vaginosis

A

clue cells (epithelial cells of vagina covered in bacteria creating a stippled appearance)

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15
Q

Changes in the Endometrium in the luteal phase are direct effect of which hormone?

A

progesterone

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16
Q

how long is the luteal phase

A

14 days

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17
Q

what info is need on endometrial biopsy

A 
age 
LMP date 
pattern of bleeding 
length of cycle
hormonal therapy 
recent pregnancy
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18
Q

what type of cancer can molar pregnancies transform into

A

choriocarcinoma

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19
Q

what is a missed miscarriage

A

<12 weeks gestation in which the dead embryo/ foetus is retained in the womb for a period of time without symptoms

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20
Q

what is the difference between partial and complete moles

A

Partial mole: tissue is triploid from a dispermic fertilisation of a
normal ovum. Fetus can be present. Can result in a live birth.
Complete mole: diploid , genetic maternal paternal, it has
duplicated from haploid sperm in an empty ovum or rarely from
dispermic fertilisation of an empty ovum. No fetus present.

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21
Q

is anti D ever given to Rhesus +ve women

A

no, will do nothing, too late to
use Anti D to ‘mop up’ fetal antibodies and
prevent an maternal immune reaction

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22
Q

a miscarriage is only up to 24 weeks, what is it called after this

A

pre term labour

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23
Q

when is anti D given

A

routinely at 28 weeks and then additional doses for

any sensitising event.

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24
Q

what causes haemolytic disease of the fetus and newborn

A

when the mother has IgG red cell alloantibodies in her plasma that cross the placenta and bind to fetal red cells possessing the corresponding antigen. Immune haemolysis may then cause variable degrees of fetal anaemia

Red cell alloantibodies in the mother occur as a result of previous pregnancies (where fetal red cells containing paternal blood group antigens cross the placenta) or blood transfusion

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25
Q

what can fetal anaemia cause

A

in the most severe cases the fetus may die of heart failure in utero (hydrops fetalis). After delivery, affected babies may develop jaundice due to high unconjugated bilirubin levels and are at risk of neurological damage

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26
Q

are test results done in a sexual health clinic visible to GP

A

no, sent with anonymous number, chi number not used

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27
Q

what are the benefits of partner notification

A

Effective form of case finding
Cost effective
Early diagnosis reduces morbidity/mortality
Reduces incidence of STI in community

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28
Q

what is the partner notification look back period for chlamydia

A

Male urethral – 4 weeks; any other infection – 6 months

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29
Q

what is the partner notification look back period for gonorrhoea

A

Male urethral – 2 weeks; any other infection – 3 months

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30
Q

what is the partner notification look back period for non specific urethritis

A

4 weeks

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31
Q

what is the partner notification look back period for trichomonas vaginalis

A

4 weeks

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32
Q

what is the partner notification look back period for epididymitis

A

As CT/GC or if negative, 6 months

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33
Q

what is the partner notification look back period for PID

A

As CT/GC or if negative, 6 months

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34
Q

what is the partner notification look back period for HIV

A

4 weeks before negative test/ before most likely time of infection

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35
Q

what is the partner notification look back period for syphilis

A

Primary; 90 days
Secondary; 2 years
Other infections; 3 months before most recent negative test

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36
Q

what infections is partner notification not needed for

A

warts
herpes
(usually have sex when asymptomatic)

not STIs:
vaginal thrush
bacterial vaginosis

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37
Q

what vaccinations can be given to prevent STIs

A 
Hepatitis B
MSM
High prevalence countries
Sexual assault
Contacts

Hepatitis A- FO transmission (sexually transmitted enteric infection):
MSM

HPV
in secondary schools
MSM aged <46

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38
Q

name two types of PrEP

A

Tenofovir disoproxil / emtricitabine

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39
Q

how can PrEP be taken

A

Daily or event-based dosing

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40
Q

what infections can PEPSE stop

A

hep b and HIV

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41
Q

hoe is hep B PEPSE taken

A 
HBV vaccine (up to 7 days)
Immunoglobulin (vaccine non-responders)
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42
Q

how is HIV PEPSE taken

A

3 antiretrovirals
Start within 72 hours
28 days total
Probably 80% effective

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43
Q

what is rape defined as

A

Penetration of the vagina, anus or mouth by the penis without consent

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44
Q

when is sexual consent invalidated

A

Incapacitated by alcohol or drugs
Incarcerated
Violence or threat of violence

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45
Q

how common is rape

A

25% of women worldwide

perpetrator usually known by victim

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46
Q

what are the sequelae of rape for the victim

A 
Injuries
Unwanted pregnancy
STI
Psychological sequelae common
-PTSD
-Anxiety/depression
-Psychosexual morbidity
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47
Q

what should you consider in patients who have experienced recent rape

A

Consider forensic examination (If theres a possibility they would want to go to court have to do forensic exam first )
Immediate safety
Injuries
HBV vaccination
Consider PEPSE
STI/pregnancy care (Windows for test- will need to com back)
Bedding, tampons etc can also be given to forensics

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48
Q

what is the medium/ long term management for rape victims

A 
Screening for STIs
Assessment of coping abilities
PTSD
HBV vaccines if indicated
Practical and psychosocial support
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49
Q

who is usually to victim/ perpetrator of gender based violence

A

towards women/ children (increases in pregnancy) usually by men

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50
Q

what are types of gender based violence

A 
Domestic abuse
Rape and sexual assault
Childhood sexual abuse
Commercial sexual exploitation
Stalking/harassment
Harmful traditional practices (eg. FGM, breast ironing)
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51
Q

what are the risk factors for GBV

A 
female 
Disability
Pregnancy
Addictions
HIV
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52
Q

A 46 year old is looking for contraception. She has a BMI of 42 and smokes 20 cigarettes/day . She has a history of pelvic inflammatory disease. She also has a multiple fibroid uterus including intramural and submucous fibroid. What would you advice?

A

Progesterone only pill

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53
Q

A 17 yr old presents looking for emergency contraception. She had unprotected sexual intercourse 23 hours ago. Her last bleed was approximately 1 week ago. She has been using the combined patch but forgot to put this back on after a 7-day patch free interval. She was meant to restart using the patch 5 days ago but only remembered to restart it 2 days ago. She does not wish to have a cu IUD fitted even though she is fully aware this would be the most effective method. Which emergency contraception would you advice?

A

Give levonorgestrel emergency contraception and advise her to carry on the patch and that she can rely on this again, for contraception, in 5 days

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54
Q

A 30yo patient attends her booking appointment. She has a history of epilepsy and is currently taking Levetiracetam. What folic acid dose would you advise her to commence?

A

5mg once daily

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55
Q

A 40 yo patient is 16 weeks pregnant and has essential hypertension. She does not normally take any drugs and has no allergies. She has no other medical problems. Her BP is 150/100. What medication would advise her to start?

A

labetolol

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56
Q

A 48-year old previously well man is admitted to ITU with Type 1 respiratory failure. He is unconscious and ventilated. PCR of a broncho-alveolar lavage has confirmed Pneumocistis jiiroveci. His parents and his wife visit him daily.

Which is the most appropriate way to obtain an HIV test?

A

Obtain venous blood from the patient and request HIV antibody/antigen

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57
Q

A 28-year old MSM (man who has sex with men) presents to the sexual health clinic with a 2 week history of sore throat, fever and a rash on his chest. He last had sex 1 week ago with a regular male partner of 4 months with whom he has condomless receptive and insertive anal sex. He last had sex with a different person 1 year previously. On examination his BP and pulse are normal, his temperature is 37.9, he has small shotty neck nodes bilaterally, erythematous but not enlarged tonsils with no pus and a fine maculopapular rash to his chest. The patient is worried he may have HIV. A near-patient rapid 4th generation HIV Antibody/antigen test is non-reactive.

How do you explain the result and further management to the patient?

A

His symptoms may be due to Primary HIV infection and venous blood should be obtained and sent to the laboratory for HIV antibody/antigen testing

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58
Q

why might you avoid UPE as emergency contraception

A

y interaction with other meds (liver-enzyme
inducing drugs, antacids) and contraceptive methods (taken before
the UPA- expired implant, expired IUS, late injection, missed pills…).
You can’t quick start directly after UPA EC either but have to wait 5
days, again due to the possible interaction with hormones

With the antacid absorption is affected. With liver enzyme inducing
drugs the drug level is affected. In women with systemic progestogen
levels (see above) the drug, an anti-progestogen, becomes “saturated”
and therefore works less well as it has fewer “active” metabolites.

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59
Q

Does the HIV antibody become positive 4 weeks or 3 months after
infection?

A

The 4th generation tests can detect antibody reliably after 4 weeks of
infection. The older assays were only able to exclude infection after 3
months

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60
Q

If a mother is due to give birth soon and is diagnosed with herpes,
is the birth plan always a C-section? Or can it be a vaginal birth?

A

if within 6 weeks of delivery and primary infection- recommend cs due to high risk of neonate HSV, both mum and baby treated
If secondary
infection recommend vaginal delivery (treatment given) as low
chance neonatal HSV- vigilance of neonatal health advised and paeds
informed

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61
Q

what ARV are used in PrEP

A

Tenofovir

DF/Emtricitabine

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62
Q

what is a RITA test

A

shows the recency of HIV infection, given to everyone with a HIV diagnosis

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63
Q

Which contraceptives are not affected by

enzyme inducing drugs?

A

DMPA injection (SayanaPress, DepoProvera), the IUS and IUD

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64
Q

can you insert an IUD if there is risk of early pregnancy (already implanted)

A

An IUD should not be
inserted to disrupt an implantation and is therefore contraindicated
if there is a chance of an early pregnancy (= implanted blastocyst)

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65
Q

what is quickstarting

A

(HCPs) can offer quick
start of any method of contraception at any time in the menstrual
cycle if it is reasonably certain that a woman is not pregnant or at
risk of pregnancy from recent unprotected sexual intercourse (UPSI).
An IUS can be used to quick start contraception if there is no risk of
pregnancy, for example to somebody presenting outside of their
period for an insertion but without pregnancy risk. If there is the risk
of an early pregnancy (for example unprotected sexual intercourse
under 3 weeks ad no “natural” period since, or after having taken
emergency contraception in the past 3 weeks); then an IUS is
contraindicated.

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66
Q

what medications for PE in pregnancy

A

dalteparin

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67
Q

are ACE inhibitors teratogenic

A

yes

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68
Q

are statins contraindicated in pregnancy

A

yes

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69
Q

A 32yo patient attends antenatal clinic at 28 weeks gestation for a review as she was measuring large for dates. An ultrasound has been performed, which shows the amniotic fluid index is 30cm.

What investigation would you request?

A

glucose tolerance test

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70
Q

A 35yo patient is 1 day postnatal and had gestational diabetes in her pregnancy, which was controlled with metformin. Her BMI is 23 and she is a non-smoker. She has no family history of diabetes. She would like to know what her follow up will be with regards to diabetes. What would you advise?

A

Fasting blood sugar in 6-8weeks

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71
Q

A 25yo patient presented with bleeding and back pain. Following colposcopy and biopsy, cervical cancer is diagnosed. The doctor orders an MRI and CT scan. What will be assessed in the CT scan?

A

Distant metastases to lungs and mediastinum

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72
Q

when is term

A

37-42 weeks

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73
Q

what is a normal fetal HR

A

120-160

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74
Q

what is normal fundal height at 38 weeks

A

38 cm +/- 2cm

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75
Q

what is SVD

A

spontaneous VERTEX delivery

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76
Q

can midwifes perform episiotomies and repairs of these

A

yes

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77
Q

what are the levels of fetal cord gases

A

Normal 7.25+, borderline 7.2-7.25, abnormal <7.2= fetal acidaemia

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78
Q

are early or late deceleration on CTG usually more innocent

A

early (in time with contractions)

79
Q

is meconium normal beofre term

A

no

80
Q

what can meconium be associated with

A

post term babies
fetal distress
breech presentation

81
Q

what is the minimum progression needed on CTG

A

0.5cm per hour

82
Q

what features suggest cephalopelvic disproportion

A 
Excessive moulding 
Caput- oedema under the scalp 
Anuria 
Vuval oedema 
Haematuria
Dry and hot vagina
High station
83
Q

what is the helperr mnemonic

A 
H- call for Help 
E-evaluate for episiotomy 
L-legs: mcroberts maneuver 
P- suprapubic pressure 
E- enter- rotational maneuvers 
R-remove the posterior arm 
R- roll patient to her hands and knees and do maneuvers again
84
Q

what should variability on CTG be

A

> 5 bpm

85
Q

what is the denominator in different presentations

A 
vertex= the occiput 
breech= sacrum 
face= chin (mentum)
86
Q

what are the different positions in a vertex presentation

A 
Left occipito-anterior (LOA).  The occiput points to the left iliopectineal eminence; the sagittal suture is in the right oblique diameter of the pelvis.
Right Occipito-anterior (ROA).  The occiput points to the right iliopectineal eminence; the sagittal suture is in the left oblique diameter of the pelvis.
Left occipitolateral (LOL).  The occiput points to the left iliopectineal line midway between the ilio-pectineal eminence and the sacro-iliac joint; the sagittal suture is in the transverse diameter of the pelvis.
Right occipitolateral (ROL).  The occiput points to the right iliopectineal line midway between the ilio-pectineal eminence and the sacro-iliac joint; the sagittal suture is in the transverse diameter of the pelvis.
Left occipitoposterior (LOP).  The occiput points to the left sacro-iliac joint; the sagittal suture is in the left oblique diameter of the pelvis.
Right occipitoposterior (ROP).  The occiput points to the right sacro-iliac joint; the sagittal suture is in the right oblique diameter of the pelvis.
Direct occipito-anterior (DOA).  The occiput points to the symphysis pubis; the sagittal suture is in the anteroposterior diameter of the pelvis.
Direct occipitoposterior (DOP).  The occiput points to the sacrum; the sagittal suture is in the anteroposterior diameter of the pelvis.
87
Q

what is engagement during labour

A

descent of presenting diameters through pelvic brim

88
Q

what is internal rotation in labour

A

when occiput reaches plevic floor and rotates to the front (now in OA position)

89
Q

what is resitution in labour

A

when the head external rotates after being delivery to align with the shoulders

90
Q

what is uterine hyperstimulation

A

potential complications of labour induction
either a series of contractions lasting 2/ more minutes or a contraction frequency of five/ more in 10 minutes
may result in fetal HR abnormalities, uterine rupture or placental abruption

91
Q

what is the treatment for uterine hyperstimulation

A

terbutaline

92
Q

how do you calculate the coverage of a screening programme

A

screened population/ eligible population x 100

93
Q

A 26 year-old para 0+0 woman is admitted at 33 weeks gestation with headaches and visual disturbance. She has a history of asthma. On examination her blood pressure is 150/101mmHg. There is no proteinuria. Serum biochemistry and haematology are normal and fetal well-being is satisfactory. Which is the most appropriate treatment?

A

nifedipine 10mg po

94
Q

how do you define a delay in the 1st stage of labour

A

<2cm dilatation in 4 hours

95
Q

A 40yo woman with a twin pregnancy presents with acute onset epigastric pain, facial, leg and hand oedema, headache and visual disturbance. Her BP is 170/110 and has 4+proteinuria. CTG of both twins and normal. Twin 1 is breech. What is the most appropriate management plan?

A

Admit, administer anti hypertensives, commence magnesium sulphate infusion and plan for delivery

96
Q

what artery is most likely to be damages by the lateral port in a laparoscopic salpingectomy

A

inferior epigastric artery

97
Q

what percentage of female cancers are cervical

A

2%

98
Q

A 30 year old presents at 38 weeks gestation with headaches, visual disturbance and reduced fetal movements. Her BP is 155/101 and has 3+ proteinuria. Serum biochemistry and haematology are normal. A CTG is performed and is normal. What is the most appropriate management plan?

A

Admit, book for induction of labour and administer labetolol

99
Q

what do you have to be careful not to damage in a hysterectomy at the level of the uterine arteries

A

ureter

100
Q

what is the role of the ductus arteriosus

A

To oxygenate the fetal venous return using the right ventricle

101
Q

A previously well newborn term infant on the postnatal ward is noticed to be breathing quickly and feeding poorly
what does this sound like

A

group B strep infection

102
Q

what is the background risk of infertility

A

6%

103
Q

What organism causes both early and late onset neonatal sepsis?

A

gram -ves

104
Q

A 70 year old patient is referred to the urogynaecology clinic by the pelvic physiotherapist. Her most troublesome symptoms are nocturia, urinary frequency and incontinence. She has to wear a pad at all times and frequently floods her clothes if she does not make the toilet in time. She is otherwise fit and well and not taking any other medications. She has no allergies.

What medication would you recommend commencing in the first instance?

A

an anticholinergic medication- tolterodine

105
Q

What class of drug is mirabegron?

A

beta-3 adrenergic agonist- used to treat overactive bladder

106
Q

A 70 year old presents to gynaecology clinic with a vaginal prolapse. Following assessment and discussion, a 64mm ring pessary is inserted for management of her prolapse. When would arrange for this lady to come back for a review of her pessary?

A

6 months

107
Q

A 30 yo patient has a normal vaginal delivery and sustains a 3rd degree tear. She is fit for discharge and wants to know what her follow up will be? What would you advise?

A

physio review in 8 weeks

108
Q

what are the types of cervical cancer

A 
Squamous carcinoma (develops from CIN - HPV infection)
Adenocarcinoma (endocervical epithelium
CGIN- also HPV)
109
Q

when is endomtrriosis deep infiltrative

A

endometriosis that has penetrated deeper than 5 mm under the peritoneum

110
Q

how does endometriosis present

A

primary or secondary dysmenorrhea, bleeding disturbances, infertility, dysuria, pain on defecation (dyschezia), cycle-dependent or (later) cycle-independent pelvic pain, nonspecific cycle-associated gastrointestinal or urogenital symptoms

111
Q

what is the treatment for endometriosis

A

NSAID- ibruprofen, napoxen, mefenamic acid
combined oral contraceptive/ depot/ implant/ mirena
if dont want to take contraception: oral progesterone(Medroxyprogesterone or norethisterone)
gonadotrophin-releasing hormone (GnRH) analogues
laparoscopic removal of cyst

112
Q

what is growth of fibroids dependent on

A

oestrogen

113
Q

what are the risk factors for uterine fibroids

A 
>40 
black race
FHx of fibroids 
nulliparity 
obesity
114
Q

what is the lymph drainage of the uterus

A

iliac
sacral
aortic
inguinal

115
Q

what are the common locations of uterine fibroids

A

subserosal- commonly cause compression symptoms
pedunculated
intramural- distort the uterus, caused prolonged heavy periods, pain and pressure
submucosal- prolonged heavy period

116
Q

what are the symptoms of uterine fibroids

A 
often asymptomatic 
menorrhagia 
IMB
pelvic pressure, pain, urinary incontinence
subfertility
miscarriage
117
Q

what is mefenamic acid used to treat

A

dysmenorrhoea

118
Q

what is the management of uterine fibroids

A

asymptomatic- expectant

menorrhagia + fibroid <3cm - mirena, COCP, dept, implants, vaginal rings, patch, GnRH agonist, ullipristal acetate

menorrhagia + fibroid >3cm- myomectomy (can still get pregnant), uterine artery embolisation (can still get pregnant), hysterectomy

119
Q

what are the risk factors for endometriosis

A

delayed child bearing
women with shorter cycles/ longer duration of bleeds
early menarche, late menopause
FHx

120
Q

what are the signs of endometriosis

A

fixed retroverted uterus
adenexal mass
thickening/ nodularity of uterosacral ligament
tenderness in pouch of douglas
deep infiltrating nodules most reliably found on PV exam during menstruation

121
Q

how can endometriosis cause infertility

A

scarring and adhesions of pelvic organs

122
Q

what Ix or endometriosis

A

TVUSS
MRI
gold standard= diagnostic laparoscopy

123
Q

what is lichen sclerosis

A

chronic destructive inflammatory skin condition

thought to be autoimmune condition

124
Q

what are the peaks of age of lichen sclerosis

A

prepubertal and post menopausal

125
Q

what type of cancer is vuval cancer

A

squamous cell carcinoma

126
Q

what is the histology of lichen scleorisis

A

vacuolar degeneration at the basal layer

127
Q

what are the symptoms of vuval lichen sclerosis

A 
can be asymptomatic
pruritus vulva (worse at night)
painful vulva (ulcer, fissure or erosion)
genital or anal bleeding 
constipation 
dyspareunia (fissure at posterior fourchette/ narrowing of introitus)
sexual dysfunction
dysuria 
bruising 
loss of labia minora, burying of clitoris 
figure of eight anal involvement 
ivory white skin 
purpura
128
Q

what are the risk of vuval lichen sclerosis

A

scarring

small risk of squamous cell carcinoma

129
Q

when would you do a biopsy for lichen sclerosis

A

existing or new skin lesions that are not responsive steroid treatment

130
Q

what is the treatment for vuval lichen sclerosis

A 
steroid ointments - step down approach 
tacrolimus (2nd lines)
follow up at 3 months, 6 months then yearly 
avoid dyed underwear and irritants (perfume)
stop smoking to reduce vulval cancer 
lubricants and vaginal dilators 
lifelong self examination 
good hygeine
131
Q

what does a branching pattern of calcification on mgm suggest

A

DCIS (branching as ductal follows the ducts)

calcification will be irregular- different thickness at different areas

132
Q

how do you ensure you have removed area of calcification in a biopsy

A

can x ray it to look for calcification

133
Q

what do a stand for in B5a

A

a- in situ
B- biopsy
5- stage

134
Q

what are the treatment options for DCIS

A

WLE/ mastectomy

neo/ adjuvant therapies: radiotherapy (dont usually give hormone, no chemo as not systemic)

135
Q

how do you localised DCIS

A

put clips after mgm then localise with wires

136
Q

whats the smallest excision margin you can accept in a breast tumour

A

1mm- want to aim for 1cm

137
Q

do you need to sample nodes in DCIS

A

no- in situ

138
Q

what does a stellate abnormality of mgm suggest

A

radial scar or carcinoma

139
Q

how accurate is an USS of axillary nodes

A

60% (so take sentinel nodes in invasive carcinomas even if USS -ve)

140
Q

does chemo work well for well differentiated cancers

A

no

141
Q

how do you identify the sentinel lymph nodes

A

patent blue dye and/or radioisotope (techietium) = combo of both gives best result

142
Q

what are the components of the nottingham prognostic index

A

tumour size, grade and lymph node involvement

143
Q

when do you use a mammogram for a patient with a breast lump

A

when over 40

144
Q

what is the difference between grade 2 and 3 breast cancer

A

Grade 2- can still see some ducts but it doesn’t look normal
Grade 3- fully differentiated

145
Q

where is HER2 expressed

A

on the cell membrane- is a transmembrane protein

146
Q

what test to see HER2 overexpression and gene amplification

A

FISH HER2

147
Q

why do you put clips in breast cancers before neoadjuvant Tx

A

incase very good response and cant see on imaging where to do surgery

148
Q

what does scarring in lymph nodes suggest

A

cancer was there but treatment got rid of it

149
Q

do you biopsy a fibroadenoma in a patient <23 in tayside

A

no

150
Q

describe a firboadenoma histologically

A

bisphasic- stroma and epithelium
circumscribed
rubbery
grey/white

151
Q

what is the treatment for fat necrosis in the breast

A

drainage and antibiotics

152
Q

Tx for fibrocystic change

A

reassure

advise them to stop smoking

153
Q

what hormone increases prolactin in breastfeeding

A

decrease in prolactin inhibiting hormone

154
Q

what does oxytocin do in breast feeding

A

contracts smooth muscle to eject milk

155
Q

what is the difference between SIRS and SEPSIS

A

SIRS inflammatory response

SEPSIS SIRS with a source of infection

156
Q

what are cooper ligaments

A

suspensory ligaments of the breast

157
Q

what type of structure is the breast

A

apocrine subcutaneou gland

158
Q

what type of cancer is pagets

A

ductal carcinoma in situ

159
Q

what extra issues are there in breast cancer during pregnancy

A

hormones increase breast proliferation
sentinel node biopsy due teratogenic
cant breast feed on ipsilateral side after surgery
radiotherapy works best in first three months of cancer, cant do whilst pregnant
avoid- chemo, hormone therapy, CT, bone scan, pelvic x ray

160
Q

how long after breast cancer can you use hormonal contraceptives

A

5 years

161
Q

how long after having tamoxifen can you conceive

A

3 months after stopping

162
Q

what are the three mains things to look for in a neonate exam

A

eyes for red reflexes
hips for DDH
femoral pulse for coarctation

163
Q

what causes the closure of ductus artertiosus

A

decreased pulmonary resistance
increase PO2 (oxygen responsive vessel)
fall in prostaglandins
increased placental + systemic vascular resistance

164
Q

what are the symptoms of patent ductus arteriosus

A

cyanosis
murmur (machinery)
tachypnoeic
poor feeding

165
Q

what treatment for patent ductus arteriosus

A

indomethacin (NSAID- causes fall in prostaglandins)

supportive

166
Q

how long should you breast feeding exclusively for

A

6 months

167
Q

can you get pregnant when breastfeeding

A

no if also dont have periods

168
Q

how long post partum can you start oestrogen contraceptive pill

A

wait 6 weeks to avoid clot risk

169
Q

how does the composition of Hb change after birth

A

fetal Hb= 2 alpha + 2 gamma = higher affinity, shifts curve to the left
adult Hb= 2 alpha + 2 beta

babies born with higher concs of Hb than adults, reaches adult level at 3 months

170
Q

what chromosome is responsible for conversion of fetal to adult haemoglobin

A

chromosome 11

171
Q

how is bilirubin metabolised in the body

A

conjugated in liver

goes into small intestine via biliary system, metabolised to urobilogen -> excreted in urine and faeces

172
Q

what are the symptoms of neonatal jaundice

A

yellow skin and sclera
reduced feeding
dark urine

173
Q

what causes neonatal jaundice

A

faster fetal Hb breakdown that adult Hb synthesis

174
Q

when is jaundice in a baby pathological

A

when <24 hours or prolonged- >2 weeks term, 3 weeks pre term

175
Q

what are the main therapies for neonatal jaundice

A

phototherapy
increased feeding and rehydration
transfusion

176
Q

what is kernicterus

A

deposits of unconjugated bilirubin in basal ganglia (crosses BBB)

177
Q

what are the symptoms of kernicterus

A 
fever
reduced feeding 
high pitched crying 
hypotonia 
opisthotonus (severe hyperextension)
178
Q

what is a complication of kernicterus

A

ATHETOID cerebral palsy

179
Q

what muscle covers the majority of the pelvic side wall

A

obturator internus

180
Q

In the Figo staging system for Cervical Cancer what is Stage 4?

A

carcinoma has spread to distant organs

181
Q

A 52 yo patient presents with hot flushes and night sweats. She has a history of breast cancer and does not want to commence hormone replacement therapy. What other class of drug can be used for menopausal symptoms?

A

SSRIs

182
Q

A 55yo patient presents to her GP with a small amount of vaginal bleeding. She is otherwise well. Her last period was 5 years ago. She has hypertension and BMI is 40. She is nulliparous. What would be the most appropriate next step?

A

refer to post menopausal bleeding clinic

183
Q

is CIN3 invasive

A

no non invasive lesions

184
Q

How is Risk of Malignancy Index (RMI) calculated?

A

CA125 level x ultrasound score x menopausal score

185
Q

A 30yo patient, known to have an 8cm ovarian cyst, presents with acute abdominal pain and vomiting. She is tachycardic and has colicky abdominal pain with associated guarding. Tumour markers were done 1 month ago and were normal and MRI characterised the cyst as a likely dermoid cyst. She is currently on the elective waiting list for a cystectomy, which has been appointed in the next 3 months. What would be the most appropriate plan of care?

A

Book emergency theatre for the same day

186
Q

What type of ovarian cyst is a dermoid?

A

germ cell tumour

187
Q

A 70 yo patient is diagnosed with a high grade serous carcinoma of the ovary. Where has this tumour most likely originated?

A

fallopian tube

188
Q

Which hormone stimulates the lactiferous duct system to grow at puberty?

A

oestrogen
(After menarche progesterone induces further ductal growth and development of the rudimentary lobules at the end of the ducts)

189
Q

what is the most common histological type of breast cancer

A

invasive ductal cancer

190
Q

how many women in UK get breast cancer

A

1 in 8

191
Q

what assessment for biopsy

A

triple assessment

192
Q

A 53 year old female patient has been recalled after her first screening mammogram showing extensive microcalcifications in the inner quadrant of her left breast.

What is the most likely diagnosis?

A

ductal carcinoma in situ

193
Q

A 28 year old woman presents with a painless, firm, discrete, mobile mass, which has a solid appearance on ultrasound scan.

What is the most likely diagnosis?

A

sclerosing adenosis

194
Q

what side effects can be associated with adjuvant breast radiotherapy

A

pulmonary fibrosis
localised skin reaction
brachial plexopathy
fatigue

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